8 year old with broken leg while on year long 'trip of a lifetime' - help!

[Ls6jan]

Hi,

I'm new on here but would really appreciate some advice.

I'm a mum of triplet girls, aged 8, and we are 3 months into a 12 month trip around Asia and one of my DD has had a v bad fall and has fractured her leg in 2 places. It's a spiral fracture to the tibia (undisplaced, which is v lucky) and slightly displaced smaller fracture to the fibula.

We are in Nepal where we have had v good treatment, she is in a full leg cast to her thigh. We are told she will have this for 6 weeks (it's been 3.5 so far) then a cast change to a short cast for a further 6 weeks. We go for a check up this week, and assuming she is deemed fit to fly, the insurance are planning to send us home.

However, we are planning to refuse curtailment and continue with the trip. That is, assuming it is healing well and there are no complications. We've planned for her to continue her treatment in Thailand at a private hospital. We will have to pay ourselves for all the rest of her treatment but it's relatively inexpensive and I think we can manage it.

However, I am now suddenly having second thoughts about carrying on with the trip. Am I risking her getting the best care? Will it be OK seeing a new set of Dr's? What about physio, will we be able to get what she needs? I already feel awfully guilty about it happening in the first place. I think to be honest am I still a bit in shock and not sure how to make a decision.

My husband and all 3 kids really don't want to go home. Besides, our house is rented out and we have career breaks from our jobs, no where to live etc, going home isn't a simple option either.

Sorry for such a long post.

The things I'd really like help with are:-

• how to cope with the guilt
• how much to let her play with her sisters v's lying still. She wants to roll around on the grass with them, is this OK?
• how to help her cope, she is having tantrums of frustration at not being able to join in, and I'm struggling to cope with this
• any experience anyone has of travelling or holidays with children in casts
• any experience anyone has of getting hospital treatment overseas v's the NHS

Thank you for reading,

I don't think you will be insured for the rest of your trip? It is a huge risk.

Lots of hospital treatment in other countries is fantastic, but expensive. If you have a complication will she be covered?

why is there the choice of going on to Thailand or returning to the UK? why not stay in Nepal and really get to know the area you're in? Become locals for a while... (this view is entirely coloured by having read Turtle Feet...)

Hi,
We'll be insured for everything except the injury she's already had. I know it's a risk but I guess we can always fly home if there's complications...

First of all, what a nigthmare! I feel for you. Your trip will definitely be a very different one from the one you planned.

I fractured my tibial plateau on holiday in Thailand in October. I was taken to hospital in Koh Sammui. It's a very serious business as it's a crucial weight bearing joint. The knee is very unforgiving

I had to have surgery to put in a plate and several screws but I flew home in a cast for that. The doc gave me a fitness to fly certificate but the Insurance company wanted me to stay in Thailand for the Op. We;re still trying to claim back the travel costs because we (dh and I) ended up going against the advice of the insurance company and flying home for the op.

I was in a full cast for the first 11 days and then after the surgery I just had a brace on which was brilliant as it meant I could move my leg and get some range of motion back before all the muscles atrophied too much (which they do).

I'm now about 7 weeks after surgery (9 weeks after the accident) and I've just begun partially weight bearing. My balance is a bit off and my leg and foot are swollen. It's a long road to recovering.

Your dd is 8 wheras I am 47. Her bones will heal quicker and better BUT it's vital to make sure conditions are right for her to heal as best as possible. She'll need that knee for many years to come.

I think if it were me I'd send your dh and the other girls off to do certain things, but have a different timetable for yourself and your injured DD.

There are lots of forums about tibial plateau fractures (TBL) like KneeGuru and others with lots of in depth info (although mostly about adults).

Have you checked whether DD can fly with a broken leg?

Hi Easter Holiday,
I like this idea, and have seriously considered it. However, we have already missed our flights to Sri Lanka due to the accident and have therefore been in Nepal almost a month longer than planned, I'm starting to feel like a local! I guess it's just that we know Thailand quite well from previous visits, I've even been in the hospital we're taking her to myself when I was really ill on our pre-children backpacking trip.

However, it is still an option, would mean she could see the same drs etc...

Personally I would continue. For an otherwise healthy child of 8 an undisplaced midshaft tibial fracture should heal well. Are they definitely planning on a full length cast for six weeks regardless or will they be seeing her in a week to see if she could be changed to a below knee cast to get the knee moving?

Speak to the airline, most only won't allow flying if the cast has been applied in the previous two weeks. Otherwise they may ask for it to be split in which case I would want to have unto date X-rays to ensure adequate bone healing before splitting. Tbh if that's ok I would consider switching a below knee anyway. When is the last time she had an XR?

If at the four week mark things aren't looking like they are moving forward, I might reconsider my decision. A good sign is that she wants to do more - just so long as she's following weight earring instructions!

Hi Spidermama,

Good to hear you are on the road to recovery now, and thanks for the reply.

Sounds like a different injury, the consultant described my DD's fractures as straightforward and neither are on the knee, however much of what you say is still true. She needs to make a full recovery, it's tricky to work out what to do for the best to enable that.

I've managed to keep her almost completely still for 3.5 weeks, but as it's now feeling so much better she wants to be off! Very hard to judge what to let her do, I am being v careful but I don't really understand what is OK and what isn't, I will make sure I ask lots of questions at the hospital this week.

Not sure if this helps but DS broke his leg (spiral fracture to tibia) when he was 3.6. He was in full cast for 4 weeks then below-the-knee one for another 4 weeks.
The full leg cast was a bit hard to manage, especially when he was in pain, but once he was in the smaller cast there was no stopping him - running, scootering, climbing, etc, etc . He did struggle again when the cast finally came off, I think because it felt weird and vulnerable, but that only lasted a few days. Within weeks no-one would have guessed what he had been through and his leg strengthened and bulked up on its own with him doing normal can't-sit-still things. No-one even mentioned physio.

I would see what the doctors say but if they are happy and I was in your position I would carry on with the trip, let your DD do as much as she can (she will hopefully stop if it hurts or she gets tired) and look after yourself. I was shocked at how much it took out of me when DS first did his leg, it is physically and emotionally draining and I was at home and only dealing with the NHS.

Good luck with it all.

Hotair 3-6 months for uncomplicated paediatric tibial shaft fractures? That's a fairly pessimistic timescale surely? For adults absolutely but an eight year old? I would think (bar any complications by six she should be allowed weight bearing in some form and twelve at the latest all plasters off.

(Op this of course based on generalisations and I haven't seen your dd XRs so as always go by what your daughters doctors tell you).

Whatever you decide, dont forget to ask for injections prior to flying, to prevent blood clots, etc. Our friend needed that for flying back to Britain after he suffered a alpine fracture from skiing.

As a disclaimer, I am not a medical professional.

I think you need to give this some very serious thought.

Your daughter has fractured both bones of her lower leg. This is an incredibly important weight bearing set of bones, and at 8yo your daughter is still developing.

As a previous poster has said, with weeks or months being non-weight bearing in a cast her muscles will atrophy. This is not only a problem for her muscle tone, but this may have an effect on her bone strength. I'd be expecting that she'd need physio after the cast is off to correct this.

You need to give her the best chance of a good recovery from this injury. If you can do that either where you are, or whilst still travelling then go ahead.

I know that there are a lot of confounding factors at play here, but you need to put all of them to one side and ask yourself where you think she would be best placed to get the care and recovery that she needs?

Also, don't feel guilty about the accident. They happen.

Does it need to be an all or nothing decision at this point? Can you make a decision to go on to thailand and reassess at that point?

Yes, we have MEDIF clearance to fly to Thailand with the full leg cast.

Yes, we have MEDIF clearance to fly with the full leg cast

All I know is children's bones heal incredibly well. dD has broken both her arms around your DDs age.

Once properly set they healed up really quickly.
She was hanging off monkey bars as if nothing had happened with in a week of having the casts off.

Quite frightening when you'd seen the X-ray of both bones broken clean through and displaced sideways.

Broken bones are so common place I can't see British medical care being any better than that abroad.

In fact the first time DD broke just her ulna and it was an Indian registrar who manipulated the half healed bones straight. I've no idea if he was Indian or British trained, his English wasn't great, but he stopped her having to have a second operation and avoid her being in a cast in Disney.

As for any long term effects? Back hand spring anyone?

Thanks for all the replies.

Moreisnnogedag: She gets her 4wk X ray on Weds, I am keeping everything crossed that all is well. Previous X rays were on Day 1 and Day 7. I know the plan is to keep the long leg cast for a further 2 weeks no matter what; but I also realise plans can change and they will decide based on what they see. We have medical clearance to go with the full leg cast the following Tuesday to Thailand.

As you say further down, they have told us that she can bear some weight from 6 weeks, and all casts off by 12 weeks at the latest. Certainly the consultant we have seen feels she is fine to travel around, and has offered to speak to the new hospital, to transfer all the notes and X rays, and has even given us his home email and tel no to make sure we can get good continuity of care.

Thanks for your advice.

feetheart: Yes, it certainly does help! Thanks for sharing an optimistic story of a child with a similar injury who had such a good recovery. I realise all cases are different, but it makes me feel much better to hear this. Thanks for sharing xxx

Starballbunny: good to hear that your DD had such a good recovery too. I think you are right, the medical care is very good here and I know it is in Thailand too (I spent a year there in 1999). I just need to make sure we can keep going back to the same hospital for follow up, and make our plans around this. And be very, very flexible!

In general: There's obviously a lot of different opinions here, but thanks everyone for the advice. As someone said, we don't have to make a final decision right now. We can see the X rays this week and decide our next move, and then if any complications arise, it's £2k for us all to get on a flight home the next day, which we could do, and back to the NHS, at any time.

So for now, it's off to sleep (10pm here). Thanks again.

Personally I would just stay in Nepal a month then carry on after

Good night and good luck

I'm no medical expert but I've had my fair share of accidents abroad and my personal experience is that the medical care has been better in South East Asia than in the UK... not that that has much bearing on anything!

I'd say you should stay away. You have nowhere to live in the UK, so you'll be staying in hotels, renting somewhere temporary, moving around etc so you might as well be doing that abroad as opposed to at home.

As long as you're pacing activities so that she still feels involved but is getting the rest and recovery time she needs then you should be fine. A previous poster suggested one scheduled of activities for your other 2 and DH and an easier one for you and DD.

The guilt... now that's a different story! That will probably take time... but remind yourself you're doing the best you can for her now and there is nothing more you could have done etc. Patience for the tantrums, they'll get easier once the full cast has gone and she's more mobile. Good luck and enjoy your trip!!

Its a difficult one, i think I'd pick a location to stay in for a further 6-12wks that has the appropriate medical care- Thailand has good hospitals, Malaysia too could be an option. I'd look at your planned itinary and tweak it appropriately. Penang might be good if you haven't already visited Malaysia on your travels - it's an easy place to travel with kids, there's a couple of hospitals (we saw an excellent Singaporean paediatrician there).
We were given the option for surgery in Thailand or fly home - that was about 8m into our gap year (& for me) but we chose to stay. On return I saw uk eye consultant and they said the care I received in Thailand was better than what id have had in the uk.
I'm sure I've read a family travel blog with a broken leg, I will try and find it.

You could try asking on vagabondfamily.org but I'm not sure how active their q&a page is.